DESCRIPTION (Taken from the applicants abstract): Rheumatoid Arthritis (RA) is a chronic, inflammatory autoimmune disorder that affects 1% of the U.S. population, with women of childbearing age preferentially stricken. There is a significant reduction in life expectancy in women with RA, which is due in part to premature cardiovascular disease. Acute myocardial infarction (MI) and congestive heart failure (CHF) are the leading causes of death in RA. The etiology of cardiovascular disease in RA likely involves an interaction between inflammation-induced and immune-mediated vascular injury, traditional risk factors, and hormonal factors. In RA, synovial inflammation is characterized by CD4+ T cell activation and pro-inflammatory cytokine excess, both within the joint and in the systemic circulation. The influence of such chronic immune system stimulation on atherogenesis and cardiovascular clinical events such as MI and CHF is unknown. However, recent work has suggested that inflammation is responsible for atherosclerotic plaque disruption with vascular occlusion in non-RA patients. Increasing evidence implicates cellular and humoral components of the immune system in atherosclerotic plaque destabilization. Specifically, pro-inflammatory cytokines and CD4+ T cells have been identified in atherosclerotic lesions in association with plaque rupture and acute ischemic cardiac events, suggesting that they participate in plaque destabilization. This award will provide the opportunity for me, Mary Chester M. Wasko, MD, MSc, to obtain the specific skills necessary to develop into an independent clinical investigator. In this study I propose to: 1) determine the prevalence and predictors of vascular disease in women with RA; 2) compare the prevalence of vascular disease and associated risk factors in RA and systemic lupus erythematosus (SLE), an autoimmune disease also characterized by premature MI and CHF in young women; and 3) compare the prevalence of vascular disease in RA patients with and without a previous cardiovascular event. This study will provide valuable information for designing a future, prospective, multicenter study examining the value of B-mode ultrasound and EBCT in predicting incident cardiovascular events in patients with RA.